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Aseptic Technique Principles in Perioperative Areas (4.1.12)

Aseptic Technique Principles in Perioperative Areas (4.1.12) - Policies, Clinical, UW Health Clinical, Infection Control

4.1.12


UW HEALTH CLINICAL POLICY 1
Policy Title: Aseptic Technique Principles in Perioperative Areas
Policy Number: 4.1.12
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: April 14, 2017

I. PURPOSE

A. To establish and maintain a sterile field that provides a safe environment for the patient.
B. These practices are to minimize wound contamination and reduce patient risk for surgical site infection.

II. POLICY ELEMENTS

Aseptic technique principles will be established and maintained.

III. PRINCIPLES

A. All items within a sterile field must be sterile.
i. Inspect all sterile items before dispensing to the sterile field for package integrity, chemical process
indicator, and expiration date.
a. Maintenance of package sterility is event related, not time-related. It is dependent upon
packaging materials, handling, and storage conditions. One year shelf life dates are added
to items sterilized at Madison United Hospital Laundry (MUHL) and Central Supply. Shelf
life is determined by type of packaging: cloth wrapped items are sterile for one year, clear
plastic dust cover, peel packed items, and pan/container are considered sterile
indefinitely. Company shelf life is by the package expiration date or package integrity.
(Refer to UWHC policy #13.18, Assessing Sterility of Packaged Items at Point of Use and
Surgical Services departmental policy #2.31, Immediate Use Steam (Flash) Sterilization in
the UW Operating Room)
b. Rigid container systems should be opened on a separate surface. The external indicator
should be verified for appropriate color change. Locks should be inspected for security to
verify there has not been a breach of the container seal prior to use. The lid should be
lifted toward the person opening the container and away from the container. The filter
should be checked and changed according to the manufacturer’s written instructions.
ii. Dispense sterile items on to a sterile field in a manner which maintains the sterility of the item and
integrity of the sterile field.
a. Supplies may be flipped carefully onto the sterile field providing they do not slide over the
edge of the wrapper or peel package.
b. Some large and/or difficult to handle supplies should be handed directly to the sterile team
member.
iii. Remove any contaminated item from the sterile field immediately.
B. A sterile barrier that has been permeated must be considered contaminated.
i. Inspect sterile barriers for perforation and strike through. Avoid inadvertent contact with unsterile
items.
a. These conditions allow for microbial contamination of the sterile field. Strike through is the
mechanism by which microorganisms enter a sterile package or field when it becomes
wet. Any item that shows evidence of repeated handling should be examined closely
before using. Strike through on drapes or gowns should be returned via green laundry bag
to the laundry for testing and possible manufacturer involvement. Contact Central
Services for the green laundry bags to alert MUHL of damaged linen. Notify surgeon of
strike through and complete PSN.
ii. Keep wet sponges or laps in a basin on the sterile field.
a. Some materials are resistant to moisture, but under abrasive conditions or prolonged
exposure may cause strike through.
iii. Consider all cloth wrapped items contaminated if they drop on the floor. Items packaged in other
material should be examined closely for signs of perforation, strike through or contamination.
C. The edges of sterile containers are not considered sterile once the package is opened.
i. Opened wrappers are considered sterile to within one inch of the edge and contaminated wherever
touched by an unscrubbed person. The inner edge of a peel package seal is considered the sterile
boundary.



UW HEALTH CLINICAL POLICY 2
Policy Title: Aseptic Technique Principles in Perioperative Areas
Policy Number: 4.1.12

a. All wrapper tails should be secured when supplies are presented to the sterile field to
avoid contamination.
ii. When opening packs on tables keep hands under the cuffs or handle the wrappers close to the
ends. To open the inner wrapper, go around the package or table instead of reaching across.
D. Scrubbed persons should wear sterile gowns and gloves.
i. Gowns are considered sterile in front from chest to the level of sterile field.
a. The area of sterility in the front of the gown extends to level of sterile field because most
sterile team members work adjacent to a sterile table.
ii. The sleeves are considered sterile from 2" above the elbows to the stockinette cuff.
a. The stockinette cuff portion of the sleeve is a moisture collection area and not an effective
microbial barrier.
iii. The sterile glove should completely cover the stockinette cuff at all times.
iv. The neckline, shoulders, axilla and back of the gown are considered unsterile.
a. These areas may become contaminated by perspiration or bacteria from the hair. The
back of a wrap around gown is not considered sterile as it cannot be observed.
b. Once gowned and gloved do not place hands in the axillary area or the lap of the gown.
v. Scrubbed persons can sit if their gloved hands remain at or above waist level and the gown below
waist level does not come in contact with sterile sleeves.
vi. The correct gown should be chosen for the procedure. The gown should be large enough to
adequately wrap around the sterile team members body and completely cover the back. Fluid
resistant gowns are appropriate for most procedures, but fluid proof gown should be chosen in
procedures where contact with large amounts of blood or body fluid is expected.
a. Fluid resistant gowns will strike through when pressure is applied to a portion of the gown
that is moist with blood or body fluid.
E. Tables and other areas of the sterile field are considered sterile over their horizontal surfaces.
i. Consider the sterile back tables are sterile to 3" below the table top. The edge of the drape must
extend at least 6" beyond the table top.
a. The sterile team member may move their sterile tables with their fingers extending over
the edge of the table.
ii. Do not drop hands or other supplies or equipment below waist level.
a. The sterility cannot be monitored as the items are out of sight.
iii. When possible scrubbed persons should avoid changing levels.
iv. Handle sterile drapes as little as possible and once in position do not move or shift
a. Shifting the position of drapes may allow potential contamination from unsterile surfaces
beneath it.
v. When sterile fields are covered, they should be covered in a manner that allows the cover to be
removed without bringing the part of the cover that falls below field above the sterile field. When
covering the sterile field two sterile “cuffed” drapes should be used. The first drape is placed with
the cuff at the halfway point. The second drape is placed from the opposite side and completely
covers the cuff of the first drape.
F. Sterile team members and items touch only sterile areas. Unsterile team members and items touch only
unsterile areas.
i. Unsterile team members should not reach over the sterile field and should remain one foot from the
sterile field.
a. This provides a safety margin around the sterile field and decreases the risk of inadvertent
contamination.
ii. Group all additional sterile equipment around the patient within view of the scrubbed person.
a. This facilitates monitoring of the sterile field and prevention of contamination.
iii. Obtain needed supplies from the nurse server prior to opening packs, when the sterile back table is
positioned in front of the nurse server.
a. This will decrease inadvertent contamination of the sterile field.
G. Movement within or around the sterile field must not contaminate that field.
i. Unsterile team members should not walk between two sterile fields. If this is unavoidable, cover
jackets must be snapped or removed and a minimum of 1 foot must be maintained from sterile
field.
a. Sterile fields opened without use for extended periods of time should be evaluated for
appropriateness for subsequent patient use. If a sterile field is opened, it will remain
under constant visual observation.



UW HEALTH CLINICAL POLICY 3
Policy Title: Aseptic Technique Principles in Perioperative Areas
Policy Number: 4.1.12

ii. Face the sterile field when the circulating nurse and scrub person move around. Personnel should
avoid reaching over the sterile field.
iii. When two gowned persons must pass each other it is done face to face (sterile to sterile) or back to
back (unsterile to unsterile).
H. All items are areas of doubtful sterility are considered contaminated.
i. Prepare sterile fields as close to the start time of the procedure as possible.
a. Sterile fields opened without use for extended periods of time should be evaluated for
appropriateness for subsequent patient use.
ii. Constant monitoring of the sterile field is required by the surgical team.
a. Any breaks in technique must be brought to the attention of the surgical team and
remedied.
iii. Discard an item if the sterility of an item is in doubt.
a. An item is either sterile or unsterile.
iv. Monitor sterile fields.
a. An open sterile field requires continuous visual observation. Direct observation increases
the likelihood of detecting a breach in sterility. There is no specified amount of designated
time that a room can remain open and not used and still be considered sterile.

IV. COORDINATION

Author: Directors, Surgical Services Department
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: Reprocessing Manager; CEO, MUHL
Approval committees: Surgical Services Policy and Procedure Committee; UW Health Clinical Policy
Committee
UW Health Clinical Policy Committee Approval: March 20, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J.Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

2016 AORN Standards, Recommended Practices and Guidelines
UWHC policy #13.18, Assessing Sterility of Packaged Items at Point of Use
Surgical Services departmental policy #2.31, Immediate Use of Steam (Flash) Sterilization in the UW
Operating Room

VII. REVIEW DETAILS

Version: Original
Last Reviewed: April 14, 2017
Next Revision Due: April 2020
Formerly Known as: Surgical Services departmental policy #5.01